Surgery for prolactinomas: a better choice?

Honegger, Jürgen; Nasi‐Kordhishti, Isabella; Aboutaha, Nuran; Giese, Sabrina

doi:10.1007/s11102-019-01016-z

Cited by 54 publications

(68 citation statements)

References 45 publications

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“…In recent years, the scale of indications has tipped towards TSS due to its favorable outcome and the potential adverse effects of DAs over the long term [52]. This approach is reinforced by two recent meta-analyses confirming that disease remission can be achieved with surgery in the majority of patients [7,8].…”

Section: Discussionmentioning

confidence: 99%

First-line surgery in prolactinomas: lessons from a long-term follow-up study in a tertiary referral center

Andereggen

Frey

Andres

et al. 2021

J Endocrinol Invest

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Context Although consensus guidelines recommend dopamine agonists (DAs) as the first-line approach in prolactinomas, some patients may opt instead for upfront surgery, with the goal of minimizing the need for continuation of DAs over the long term. While this approach can be recommended in selected patients with a microprolactinoma, the indication for upfront surgery in macroprolactinomas remains controversial, with limited long-term data in large cohorts. We aimed at elucidating whether first-line surgery is equally safe and effective for patients with micro- or macroprolactinomas not extending beyond the median carotid line (i.e., Knosp grade ≤ 1). Methodology Retrospective study of patients with prolactinomas Knosp grade ≤ 1 treated with upfront surgery. The primary endpoint was patients’ dependence on DAs at last follow-up. The secondary endpoint was postoperative complications. Independent risk factors for long-term dependence on DAs were analyzed. Results A microadenoma was noted in 45 patients (52%) and a macroadenoma in 41 (48%), with 17 (20%) harboring a Knosp grade 1 prolactinoma. Median follow-up was 80 months. First-line surgery resulted in long-term remission in 31 patients (72%) with a microprolactinoma and in 18 patients (45%) with a macroprolactinoma (p = 0.02). DA therapy was ultimately required in 11 patients (24%) with microadenomas vs. 20 (49%) with macroadenomas (p = 0.03). As for the latter, DA was required in 13 patients (76%) with Knosp grade 1 macroadenomas vs. 7 patients (29%) with Knosp grade 0 macroadenomas (p = 0.004). There was no mortality, and morbidity was minimal. Knosp grade 1 prolactinomas (OR 7.3, 95% CI 1.4–37.7, p = 0.02) but not adenoma size (i.e., macroprolactinomas) were an independent predictor of long-term dependence on DAs. Conclusions First-line surgery in patients with microprolactinomas or macroprolactinomas Knosp grade 0 resulted in a good chance of non-dependency on DA therapy. However, in patients with prolactinomas Knosp grade 1, first-line surgery cannot be recommended, as adjuvant DA therapy after surgery is required in the majority of them over the long term.

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Section: Discussionmentioning

confidence: 99%

First-line surgery in prolactinomas: lessons from a long-term follow-up study in a tertiary referral center

Andereggen

Frey

Andres

et al. 2021

J Endocrinol Invest

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“…However, when dopamine agonists are ineffective or cause inacceptable adverse effects, endoscopic transsphenoidal prolactinoma resection is recommended. This type of surgery is safe and effective, with remission rates of 50-90% (2,(9)(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Prolactinomas: Prognostic Factors of Early Remission After Transsphenoidal Surgery

Zieliński

Ozdarski²,

Maksymowicz

et al. 2020

Front. Endocrinol.

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Results: Of 48 patients, 38 (79%) achieved early biochemical remission at 3 months. Patients in early remission at 3 months had lower serum prolactin concentrations on the first postoperative day than patients with recurrent or persistent hyperprolactinemia (p < 0.001). Using univariate logistic regression, larger maximum tumor diameter (p = 0.014), higher Knosp grade (p < 0.001), and plurihormonality predicted remission at 3 months (p = 0.021). However, using multivariate stepwise logistic regression, only the Knosp grade remained significant (p < 0.001). Conclusions: Radiological assessment of prolactinoma invasiveness (Knosp grades) and early postoperative serum prolactin concentrations are important predictors of early remission following transsphenoidal prolactinoma resection.

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“…Medical treatment may be temporary, although recent reviews have shown lower remission rates than previously thought (21-36.6%) [9,11,12], suggesting the need for long-term medical treatment [11,12], including ongoing follow-up by endocrinologists and other healthcare professionals [6]. In case of resistance or intolerance to medical therapy, and depending on patient preference, transsphenoidal selective adenomectomy can be considered as alternative treatment option [6,13].…”

Section: Introductionmentioning

confidence: 99%

Healthcare utilization and costs among prolactinoma patients: a cross-sectional study and analysis of determinants

et al. 2020

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Purpose Prolactinomas are the most prevalent functioning pituitary adenomas. They affect gonadal function as well as health-related quality of life (HRQoL). This study aimed to report healthcare utilization and costs, including their determinants, for prolactinoma patients. Methods Cross-sectional study of 116 adult prolactinoma patients in chronic care in a Dutch tertiary referral center. Patients completed four validated questionnaires, assessing healthcare utilization and costs over the previous 12 months (Medical Consumption Questionnaire), disease bother and needs (Leiden Bother and Needs Questionnaire Pituitary), HRQoL (Short Form-36), and self-reported health status (EuroQol 5D). Regression analyses were used to assess associations between disease-related characteristics and healthcare utilization and costs. Results Mean age was 52.0 years (SD 13.7) and median follow-up was 15.0 years (IQR 7.6–26.1). Patients visited the endocrinologist (86.2%), general practitioner (37.9%), and ophthalmologist (25.0%) most frequently. Psychological care was used by 12.9% of patients and 5% were admitted to hospital. Mean annual healthcare costs were €1928 (SD 3319), mainly for pituitary-specific medication (37.6% of total costs), hospitalization (19.4%) and specialist care (16.1%). Determinants for higher healthcare utilization and costs were greater disease bother and needs for support, lower HRQoL, elevated prolactin, and longer disease duration, while tumor size, hypopituitarism and adrenal insufficiency were not significantly associated with healthcare utilization and costs. Conclusion Healthcare utilization and costs of prolactinoma patients are related to patient-reported HRQoL, bother by disease and needs for support. Therefore, addressing patients’ HRQoL and needs is a way forward to improve efficiency of care and patients’ health status.

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Surgery for prolactinomas: a better choice?

Cited by 54 publications

References 45 publications

First-line surgery in prolactinomas: lessons from a long-term follow-up study in a tertiary referral center

First-line surgery in prolactinomas: lessons from a long-term follow-up study in a tertiary referral center

Prolactinomas: Prognostic Factors of Early Remission After Transsphenoidal Surgery

Healthcare utilization and costs among prolactinoma patients: a cross-sectional study and analysis of determinants

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